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Patho- Neuro > Neuro Mod 3 > Flashcards

Neuro Mod 3 Flashcards

1
Q

what does the thalamus relay?

A

sensory input to the cortex

gateway to the cortex

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2
Q

what does the relay center of the thalamus do before projecting to cortex

A

MODIFIES and projects ALL INPUT to the cortex (except CN1)

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3
Q

What is the input to thalamus?

A

ALL sensory must pass through except CN1 (pain input MODIFIED at thalamus)
motor passes through via basal ganglia
limbic system connects to thalamus - thus plays role in emotional behavior

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4
Q

What is the output from thalamus?

A

most fibers project to the cortex - some project to limbic areas and basal ganglia

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5
Q

What is the somatosensory input to the thalamus?

A

enters consciousness

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6
Q

What is the structure of the thalamus?

A

oval shaped cluster of nuclei that comprises 80% of diencephalon

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7
Q

What are the anatomical divisions of the thalamus?

A 
anterior division - anterior nucleus
medial division - dorsomedial nucleus (DM)
Lateral division
intralaminar nuclei
reticular nuclei
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8
Q

What are the 4 parts of the lateral division of the thalamus?

A

dorsal tier - lateral dorsal, lateral posterior, pulvinar
lateral tier - ventral anterior, ventral lateral, ventral posterior, ventral posterolateral, and ventral posteromedial
medial geniculate
lateral geniculate

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9
Q

What are the 3 functional categories/roles of the thalamus?

A
  1. communicate specific sensory input to the appropriate area of the cerebral cortex
  2. Decision maker
  3. functional role for the basal ganglia and limbic system
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10
Q

Give an example of the specific communication role in the thalamus?

A

somatosensory input from the thumb project to the VPL of the thalamus which projects to the thumb in primary somatosensory area (3,1,2)

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11
Q

What is the decision maker role of the thalamus?

A

decides about which form of information should be projected to the cerebral cortex for processing (gate keeper/distribution role between the areas of the cortex)
Has regulatory inputs

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12
Q

Give an example of regulatory inputs in the thalamus?

A

areas of parietal lobe project to the lateral posterior nucleus (an association nucleus) which in turns project back to the parietal lobe of the cortex

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13
Q

What is the functional role for the basal gangle and limbic system in the thalamus?

A

basal ganglia and limbic system project to thalamic nuclei (intralaminar and midline nuclei) which project to both the cortex and back to the basal ganglia or limbic system

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14
Q

Describe the 3 pathology steps of the thalamus?

A
  1. central pain
  2. thalamic pain
  3. thalamic syndrome
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15
Q

What is the internal capsule?

A

bundle of fibers (white matter) located between thalamus/caudate nucleus and the lenticular nucleus

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16
Q

what is the broad expense of white matter spanning up and out to the cortex within the internal capsule?

A

corona radiata

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17
Q

What are the 5 parts of internal capsule?

A 
anterior limb
posterior limb
genu
retrolenticular part
sublenticular part
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18
Q

what does the anterior limb of internal capsule contain?

A

fibers connecting anterior nucleus (thalamic relay nucleus) to cingulate
dorsomedial nucleus (association nucleus) to prefrontal
also projects from frontal lobe to pontine nuclei in brainstem (frontopontine fibers)

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19
Q

What does the posterior limb of internal capsule contain?

A

ascending/descending motor and sensory pathways

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20
Q

what is the genu in the internal capsule?

A

transition area between anterior and posterior limbs

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21
Q

What does the retrolenticular part of the internal capsule contain?

A

fibers connecting thalamus to posterior lobes of cerebral cortex (parietal and occipital)
projections between LP/pulvinar to/from parietal/occipital cortex
optic radiation

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22
Q

What is optic radiation?

A

projection from thalamus to visual cortex (17-occipital lobe)
found in retrolenticular part of internal capsule and sublenticular part

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23
Q

What does sublenticular part of internal capsule contain?

A

optic radiation

fibers of auditory radiation

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24
Q

What is auditory radiation?

A

projection from thalamus to auditory cortex (41-temporal lobe)

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25
Q

What is the pathology of the internal capsule?

A

stroke

contains perforating arteries

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26
Q

What are perforating arteries?

A

numerous small branches that originate from the circle of Willis and the ACA, MCA, PCA and basilar arteries

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27
Q

What do the perforating arteries supply within the internal capsule?

A

sub cortical regions

  1. diencephalon (thalamus, hypothalamus, subthalamus)
  2. internal capsule -pathway of myelinated axons leaving and entering the cerebral cortex (located between thalamus and basal ganglia)
  3. limbic structures
  4. pons
  5. cerebellum
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28
Q

What is infarction (occlusion) in the perforating arteries in the internal capsule called?

A

lacunar stroke/small vessel stroke

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29
Q

What blood supply is affected in the lacunar stroke?

A

supply to the internal capsule (and thalamus)
lenticulostriate arteries of MCA
perforating arteries of ACA and anterior communicating artery

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30
Q

3 RF of the lacunar stroke?

A

HTN
smoking
and DM

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31
Q

depending on location of lacunar stroke may present how?

A

pure motor, ataxic, mixed motor/sensory and pure sensory

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32
Q

Pathology of lacunar stroke?

A

micro-deposits of CT of fatty tissue blocks artery
obstruction results in small necrotic tissue
necrotic tissue is removed by macrophages leave hole -cystic lesion
small penetrating arteries are not usually directly affected by athrerosclerosis

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33
Q

4 common patterns of lacunar stroke?

A

pure motor stroke (MC form)
ataxic hemiparesis (2nd MC form)
Mixed motor and sensory involvement
Pure sensory stroke

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34
Q

What is a pure motor stroke?

A

contralateral hemiparesis/hemiplegia

face/arms/hands/legs

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35
Q

what is ataxic hemiparesis stroke?

A

combination of cerebellar/motor symptoms
site of lesion involves cerebellar tracts as well as motor pathways
homolateral ataxia and crural paresis

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36
Q

What is mixed motor and sensory involvement?

A

contralateral hemiparesis and hemiparaesthesia

face/arm/trunk/leg

37
Q

What is a pure sensory stroke?

A

contralateral hemiparaesthesia along face/arm/leg/trunk

usually affects limbs more than face/trunk

38
Q

What is the function of a basal ganglia?

A

modify motor control - initiation & execution of motor activity

39
Q

What is the structure of a basal ganglia?

A

group of nuclei located bilaterally deep in the telencephalon, diencephalon, and midbrain

40
Q

What are the 5 major nuclei of the basal ganglia?

A 
putamen
caudate nucleus
nucleus accumbens
globus pallidus
other - substania nigra (midbrain), subthalamus (diencephalon)
41
Q

What are lentiform nuclei?

A

putamen and globus pallidus

42
Q

What is striatum?

A

putamen, caudate nucleus and nucleus accumbens

43
Q

What is corpus striatum?

A

all three- putamen, globus pallidus and caudate nucleus

44
Q

what do the basal ganglia stimulate the thalamus to do?

A

either increase or decrease thalamic drive to the motor cortex
thalamic drive to cortex

45
Q

What does increased thalamic drive result in?

A

increasing the motor output from motor cortex

if too much drive excessive unwanted movement (hyperkinetic)

46
Q

What does decreased thalamic drive result in?

A

decreasing the motor output from motor cortex

if too little drive - not enough movement (hypokinetic)

47
Q

Basal ganglia are always sending input to the thalamus that does what?

A

increase inhibition or decrease inhibition

the balance between the 2 determines whether the thalamus is inhibited or stimulated

48
Q

if thalamus is stimulated/inhibited then thalamic drive is what

A 
inhibited=  decreased
stimulated= increased
49
Q

What is the direct pathway of the basal ganglia to the thalamus cortex-striatum?

A

GP/SNr-thalamus -cortex

50
Q

What is the function of the direct pathway of basal ganglia?

A

stimulates thalamic drive to motor cortex
decreases inhibition which results in increased thalamic drive
facilitates movements

51
Q

What is the indirect pathway of the basal ganglia to the thalamus?

A

this pathway involves the subthalamic nucleus and its influence on the GP
cortex-striatum -GP-STh-GP-thalamus-cortex

52
Q

What is the function of the indirect pathway of the basal ganglia?

A

inhibits thalamic drive to motor cortex
increases inhibition on the thalamus which decreases thalamic drive
inhibits unwanted movements

53
Q

Disorders of the basal ganglia are commonly classified as what 2 types?

A

hyperkinetic

hypokinetic

54
Q

What happens with hypokinetic movement disorders?

A

an absence or difficulty with intended movements

ex: bradykinesia & rigidity

55
Q

What happens with hyperkinetic movement disorders?

A

extraneous unwanted movements

ex: chorea, athetosis, ballismus

56
Q

What is Chorea?

A

involuntary, constant, rapid, complex body movements that flow from one body part to another

57
Q

What is choreiform

A

resembling chorea

involuntary dance like movement of the limbs

58
Q

What is athetosis?

A

slow, writhing movements of the fingers and hands and sometimes the toes

59
Q

What is ballismus?

A

violent, flailing movements

damage to subthalamic nuclei of basal ganglia results in hemiballismus

60
Q

What is dystonia?

A

a persistent spasm/posture of a body part which can result in grotesque movements and distorted positions of the body

61
Q

What is a resting tremor?

A

occurs when a body part is at complete rest against gravity

tremor amplitude decreases with voluntary activity

62
Q

What is a postural tremor?

A

occurs during maintenance of a position against gravity and increases with action

63
Q

What is essential tremor?

A

MC form of tremor

occurs in a person who is moving or trying to move and no cause can be identified

64
Q

What is an intentional tremor?

A

manifests as a marked increase in tremor amplitude during a terminal portion of targeted movement
example include cerebellar tremor/pathology

65
Q

What is bradykinesia?

A

slowing of voluntary movement

66
Q

What is cogwheel rigidity?

A

periodic resistance at different points throughout the range of movement

67
Q

What is spasticity?

A

is speed-dependent

move slow and can move limb through ROM

68
Q

What is one of the MC (hypo kinetic) neurological disorders in individuals >60 yo

A

Parkinson’s Disease

69
Q

What are the manifestations of PD

A

bradykinesia
difficulty initiating movement (use center of gravity to compensate)
increased muscle tone -lead-pipe rigidity and cogwheel rigidity
resting tremor - pill rolling, diminishes/abolishes with movement
decreased voluntary movements
other s/s - dementia and depression secondary to lesions in brainstem

70
Q

what do the decreased voluntary movements in PD lead to?

A

decreased facial expression masked expression
quiet monotone speech
micrographia (small writing)

71
Q

What is the pathology of PD?

A

destruction of the substantia nigra (reduced dopamine production)
net result decreased thalamic drive to motor cortex

72
Q

What is the pathway of reduced thalamic drive in PD?

A

PD inhibits the direct pathway= decreased thalamic drive

PD allows the indirect pathway to dominate=decreased thalamic drive

73
Q

2 causes of Parkinson’s disease

A

Genetic - 1st degree relative: 2-3x’s risk of developing PD

Environmental - pesticide exposure, narcotic agent MPTP, trauma

74
Q

Huntington’s Disease

A

(hyperkinetic) a degenerative neurological disease that manifests in choreiform movement, dementia and behavioral changes

75
Q

Where does the choreiform movements begin in Huntington?

A

in the face/arms and progress to whole body

76
Q

What is dementia?

A

short term memory deficits, poor ability to plan, organize and sequence, slow thinking (bradyphrenia)

77
Q

What are the behavioral changes seen in Huntington?

A

apathy, disinhibition, irritability also depression/euporia changes

78
Q

when is the usual onset of Huntingtons?

A

middle age and often progresses to death in 10-15 years

79
Q

What is the pathology of Huntingtons?

A

severe degeneration of striatum (caudate and putamen nucleus) and frontal cortex
impairs the direct and indirect pathways

80
Q

What does Huntingtons do to the direct pathway?

A

facilitates AND inhibits direct pathway at some level

the direct pathway normally decreases inhibition on the thalamus increasing thalamic drive

81
Q

Huntington’s does what in the indirect pathway?

A

inhibits

increases inhibition results in decreased thalamic drive

82
Q

What does tardive mean?

A

delayed or belated onset of symptoms

83
Q

What is tardive dyskinesia?

A

characterized by involuntary uncontrollable movements esp of mouth, tongue, trunk and limbs
ex: tics and other involuntary, uncontrollable writhing movement patterns

84
Q

How does tardive dyskinesia occur?

A

as a SE of prolonged use of antipsych drugs or dopamine antagonists
pt may be put on a drug holiday to prevent or treat (3-6months)

85
Q

What is a tic?

A

rapid and repeated and stereotyped involuntary movements

can range from simple benign tic to more severe syndrome such as Tourettes syndrome

86
Q

What is tourettes syndrome characterized as?

A

motor and vocal tics

87
Q

How is diagnosis of tourettes made?

A

presence of both motor and vocal tics
occurrence of multiple tics nearly every day through period of 1 yr - without remission of tics for a period of greater than 3 consecutive months
symptoms cause distress or impairment of in functioning

88
Q

What is the age of onset of tourettes?

A

<18

Patho- Neuro (5 decks)

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